Systematic review: Acupuncture and IVF: Acupuncture improves rates of pregnancy and live birth

bmj-infertility-acupuncture1Effects of acupuncture on rates of pregnancy and live birth among women undergoing in vitro fertilisation: systematic review and meta-analysis

Eric Manheimer, research associate1, Grant Zhang, assistant professor1, Laurence Udoff, assistant professor2, Aviad Haramati, professor3, Patricia Langenberg, professor and vice-chair4, Brian M Berman, professor1, Lex M Bouter, professor and vice chancellor (rector magnificus)5

1 Center for Integrative Medicine, University of Maryland School of Medicine, 2200 Kernan Drive, Kernan Hospital Mansion, Baltimore, MD 21207, USA, 2 Department of Obstetrics, Gynecology and Reproductive Services, University of Maryland School of Medicine, 3 Department of Physiology and Biophysics and Medicine, Georgetown University School of Medicine, Washington, DC, 4 Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, 5 VU University Amsterdam De Boelelaan 1105, 1081 HV Amsterdam, the Netherlands

Correspondence to: E Manheimer emanheimer@compmed.umm.edu
Objective To evaluate whether acupuncture improves rates of pregnancy and live birth when used as an adjuvant treatment to embryo transfer in women undergoing in vitro fertilisation.

Design Systematic review and meta-analysis.

Data sources Medline, Cochrane Central, Embase, Chinese Biomedical Database, hand searched abstracts, and reference lists.

Review methods Eligible studies were randomised controlled trials that compared needle acupuncture administered within one day of embryo transfer with sham acupuncture or no adjuvant treatment, with reported outcomes of at least one of clinical pregnancy, ongoing pregnancy, or live birth. Two reviewers independently agreed on eligibility; assessed methodological quality; and extracted outcome data. For all trials, investigators contributed additional data not included in the original publication (such as live births). Meta-analyses included all randomised patients.

Data synthesis Seven trials with 1366 women undergoing in vitro fertilisation were included in the meta-analyses. There was little clinical heterogeneity. Trials with sham acupuncture and no adjuvant treatment as controls were pooled for the primary analysis. Complementing the embryo transfer process with acupuncture was associated with significant and clinically relevant improvements in clinical pregnancy (odds ratio 1.65, 95% confidence interval 1.27 to 2.14; number needed to treat (NNT) 10 (7 to 17); seven trials), ongoing pregnancy (1.87, 1.40 to 2.49; NNT 9 (6 to 15); five trials), and live birth (1.91, 1.39 to 2.64; NNT 9 (6 to 17); four trials). Because we were unable to obtain outcome data on live births for three of the included trials, the pooled odds ratio for clinical pregnancy more accurately represents the true combined effect from these trials rather than the odds ratio for live birth. The results were robust to sensitivity analyses on study validity variables. A prespecified subgroup analysis restricted to the three trials with the higher rates of clinical pregnancy in the control group, however, suggested a smaller non-significant benefit of acupuncture (odds ratio 1.24, 0.86 to 1.77).

Conclusions Current preliminary evidence suggests that acupuncture given with embryo transfer improves rates of pregnancy and live birth among women undergoing in vitro fertilisation.

Electro acupunture increases ovarian blod flow (PCOS)

fertility and sterility acupunctureEffect of electro-acupuncture stimulation of different frequencies and intensities on ovarian blood flow in anaesthetized rats with steroid-induced polycystic ovaries
Elisabet Stener-Victorin1 ,2 , Rie Kobayashi3 , Orie Watanabe3 , Thomas Lundeberg4 and Mieko Kurosawa3
1Department of Physiology, Sahlgrenska Academy, Göteborg University, Box 432, SE-405 30 Göteborg, Sweden
2Department of Obstetrics and Gynecology, Sahlgrenska Academy, Göteborg University, Sahlgrenska University Hospital, Sahlgrenska, SE-413 45 Göteborg, Sweden
3Basic Medical Research Centre, International University of Health and Welfare, 2600-1 Kitakanemaru, Otawara, Tochigi 324-8501, Japan
4Department of Rehabilitation Medicine, Karolinska Hospital, SE-171 77 Stockholm, Sweden

Abstract

Background

Maintenance of ovarian blood flow (OBF) is suggested to be important for regular ovulation in women with polycystic ovaries (PCO). The purpose of the present study was to investigate whether electro-acupuncture (EA) of different frequencies and intensities can improve the OBF of anaesthetized rat in the animal model of PCO.

Methods

PCO was experimentally induced by a single intramuscular (i.m.) injection of estradiol valerate (EV) in rats. Control rats were given i.m. injection of oil. The involvement of the two ovarian sympathetic nerves; superior ovarian nerve (SON) and plexus ovarian nerve (OPN), in OBF responses was elucidated by severance of SON and OPN in both control and PCO rats. How systemic circulatory changes affect OBF was evaluated by continuous recording of the blood pressure. OBF was measured on the surface of the ovary-using laser Doppler flowmetry. Acupuncture needles were inserted bilaterally into the abdominal and hind limb muscles and connected to an electrical stimulator. Two frequencies – 2 Hz (low) and 80 Hz (high) – with three different intensities – 1.5, 3, and 6 mA – were applied for 35 s.

Results

Low-frequency EA at intensities of 3 and 6 mA elicited significant increases in OBF in the Control group compared to baseline. In the PCO group the increases in OBF were significant only when stimulating with low-frequency EA at 6 mA. After severance of the ovarian sympathetic nerves, the increased response of OBF that had been induced by low-frequency EA in both the Control and PCO group was abolished, indicating that the OBF response is mediated via the ovarian sympathetic nerves. High-frequency EA at 6 mA significantly decreased OBF and mean arterial blood pressure (MAP) in the Control group compared to baseline. In the PCO group, the same stimulation produced similar decreases in MAP, but not in OBF.

Conclusion

Low-frequency EA stimulation with a strong intensity (6 mA) increases OBF in rats with steroid-induced PCO whereas less strong intensity (3 mA) induces similar changes in control rats. Severance of the ovarian sympathetic nerves, abolish this OBF increase in both study groups, which suggests that the responses of OBF to EA are mediated via the ovarian sympathetic nerves.
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How acupuncture stimulates ovulation (the mechanism)

Clinical studies on the mechanism for acupuncture stimulation of ovulation
Mo X; Li D; Pu Y; Xi G; Le X; Fu Z Zhejiang College of Traditional Chinese Medicine, Hangzhou.

Ovulatory dysfunction is commonly seen in gynecology clinic. It may cause infertility, amenia, functional uterine bleeding and a variety of complications. This research according to TCM theory records treating with acupuncture 34 patients suffering from ovulatory dysfunction. Changes in clinical symptoms and some relative targets are reported, plus findings in animal experiments. The theory concerning the generative and physiologic axis of women, this research involved the following points; Ganshu (UB 18), Shenshu (UB 23), Guanyuan (Ren 4), Zhongji (Ren 3), and Sanyinjiao (Sp 6). The reinforcement and reduction of acupuncture enables it to strengthen liver and kidney. Through the Chong and Ren channels it nourishes uterus to adjust the patient’s axis function and recover ovulation. Treated on an average of 30 times, the patients’ symptoms improved to varying degrees. The marked effective rate was 35.29%, the total effective rate being 82.35%. BBT, VS, CMS, and B ultrasonic picture all improved to some degree. The results also showed that acupuncture may adjust FSH, LH, and E2 in two directions and raise the progesterone level, bringing them to normal. The animal experiments confirmed this result. Results showed that acupuncture may adjust endocrine function of the generative and physiologic axis of women, thus stimulating ovulation. The results of this research will provide some scientific basis for treating and further studying this disorder.

In anovulatory infertility cases the hyperactive sympathetic system can be depressed by electro acupuncture and the function of the hypothalamus-pituitary-ovarian axis can be regulated by electro acupuncture via central sympathetic system

Relationship Between Blood Radioimmunoreactive Beta-Endorphin and Hand Skin Temperature During The Electro-Acupuncture Induction of Ovulation

By Chen Bo Ying M.D. Lecturer of Neurobiology
Institute of Acupuncture Research, and Yu Jin, MD., Prof of Gynecology Obstetricus and Gynecology Hospital Shanghai Medical University Shanghai, People’s Republic of China

Abstract:

Thirteen cycles of anovulation menstruation in 11 cases were treated with Electro-Acupuncture (EA) ovulation induction. In 6 of these cycles which showed ovulation, the hand skin temperature (HST) of these patients was increased after EA treatment. In the other 7 cycles ovulation was not induced. There were no regular changes in HST of 5 normal subjects. The level of radioimmunoreactive beta-endorphin (rß-E) fluctuated, and returned to the preacupunctural level in 30 min. after withdrawal of needles in normal subjects. After EA, the level of blood rß-E in cycles with ovulation declined or maintained the range of normal subjects. But the level of blood rß-E and increase of HST after EA (r=-0.677, P <0.01). EA is able to regulate the function of the hypothalamic pituitary-ovarian axis. Since a good response is usually accompanied with the increase of HST, monitoring HST may provide a rough but simple method for prediciting the curative effect of EA. The role of rß-E in the mechanism of EA ovulation induction was discussed.

KEYWORDS: Electro-Acupuncture (EA), Hand Skin Temperature (HST), radioimmunoreactive beta-endorphin (rß-E), ovulation, radioimmunoassay (RIA).
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Acupuncture, IVF/ICSI and follicle development

fertility and sterility acupunctureAcupuncture Treatment For Infertile Women Undergoing Intracytoplasmic Sperm injection
Sandra L. Emmons, MD
Phillip Patton, MD

Source: Medical Acupuncture, A Journal For Physicians By Physicians
Spring / Summer 2000- Volume 12 / Number 2
"Aurum Nostrum Non Est Aurum Vulgi"

Table 1. Outcomes for Acupuncture vs Non-Acupuncture Cycles Among 6 Women Undergoing ICSI*
Patient No.
Age, y
Non-Acupuncture Cycles
AcupunctureCycles
Follicles Cycles Follicles Cycles
Mean No. No. Mean No. No. Outcome
1 29 4.7 3 8 1 IUP
2 34 2 1 10 2 SAB twice
3 36 3 2 14 1 SAB
4 37 8 1 6 1 No pregnancy
5 38 1 1 4 1 Cycle canceled
6 41 2 1 6 1 SAB
Mean (SD) 3.7 (1.0) 8.4 (1.3)
*ICSI indicates intracytoplasmic sperm injection; IUP, intrauterine pregnancy; and SAB, early spontaneous abortion. P=.02 for overall acupuncture follicles vs non-acupuncture follicles.

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Chinese herbal medicine – higher success rates of pregnancy, no side-effects

Measuring the Effectiveness of Chinese Herbal Medicine in Improving Female Fertility

By: Trevor A. Wing & Elke S. Sedlmeier

Keywords: Infertility, Chinese herbal medicine, ultrasound, hormone levels.

Aim: To determine the relationship between female fertility indicators and the administration of
Chinese herbal medicine (CHM).

Design: A prospective cohort clinical study to measure accepted bio-medical
factors that affect female fertility and to determine if CHM can improve these factors as well as pregnancy outcome.

Setting: A private practice specialising in treating infertility with traditional Chinese medicine (TCM). The study took place between November 2003 and December 2004. Patient(s): Fifty women with the Western medical diagnosis of unexplained infertility.

Interventions: One monitored menstrual cycle measuring pre-treatment fertility factors, followed by treatment with Chinese herbal medicine and subsequent measurement of the changes in the same fertility factors.

Results: Significant differences were observed between the two time points for the majority of factors measured. Pregnancies in the sample group recorded 6 months after commencement of the last treatment were 28, with 11 live births and 7 miscarriages.

Conclusion: The study outcome demonstrates that using Chinese herbal medicine results in higher success rates of pregnancy, with no patient side-effects and a reduction in the category of patients conventionally classified as having unexplained infertility.

Introduction

The research question this study seeks to answer is “Does administering Chinese herbal medicine (CHM) improve the physiological factors affecting human female fertility?” The hypothesis is that administering CHM improves the main physiological factors affecting human female fertility and therefore also the pregnancy
rate. These factors are ovarian follicle number and size, uterine endometrium thickness, uterine artery
haemodynamics, serum follicle stimulating hormone (FSH), serum progesterone levels and corpus luteum
vascularity.
Research aims and objectives

1. Establish a sample group of 50 new patients registering for fertility treatment at a London natural health fertility clinic.
2. Test and record a predetermined group of twelve measurements prior to treatment during one menstrual cycle.
3. Administer CHM in capsule form for one menstrual cycle.
4. Re-test the same parameters in the third cycle of treatment, continue to administer CHM for six months (or until pregnancy is achieved if this occurs in less than six months). Follow up six months after the beginning of the last patient’s treatment
5. To determine the number of pregnancies achieved.
6. Analyse results and discuss findings.
7. Draw conclusions and make recommendations for further practice and study.

Methodology

The challenge for any investigative method when applied to traditional Chinese medicine (TCM) is that
in everyday practice, the same disease in different patients will have a different treatment principle
and herbal prescription. The information collected from the traditional Chinese examination and
assessment determines a diagnosis based on pattern differentiation and hence a treatment principle and
formula which is individualised for each patient. In our treatment of infertility there is, in addition,
a weekly modification of each patient’s formula. As there is thus no standardisation of formulae for
patients it is not appropriate to discuss the formulae themselves in this study, but rather to simply study
the effects of Chinese herbal medicine treatment on female fertility.

The method chosen was a prospective cohort primary study using a sample group of patients registered
with the clinic for TCM infertility treatment.

Patients were selected for the study on the basis that they had no Western medical condition which might have affected their fertility. In other words they were described in Western medical terms as having unexplained infertility. They also entered the study on the condition that data obtained in the course of their treatment could be used in the study anonymously.

Effect of Chinese medicinal herbs on sperm membrane of infertile male

Effect of Chinese medicinal herbs on sperm membrane of infertile male
[Article in Chinese]

Liu XD.

Shandong Institute of Traditional Chinese Medicine and Materia Medica, Jinan.

The authors carried on the quantitative analysis of fluorescence polarization degree and fluorescent intensity on wheat germ agglutinin (WGA) receptor in sperm membrane surface and protein macromolecule 1-Anilinonaph thalene-8-suphonic acid salt (1,8-ANS) of sperm membrane to the patients with infertility and adult male with normal fertility, with the method of ultraviolet microspectrofluorometer (SMP, type: 05, made in West Germany). The results were as follows: the patient’s WGA receptor in sperm membrane surface was decreased (P less than 0.001), and the 1, 8-ANS of fluorescent intensity in hydrophobic area of protein macromolecule of sperm membrane was increased (P less than 0.05). After the treatment of Shenjing Zhongzitang, WGA receptor was increased obviously and 1, 8-ANS of fluorescent intensity was changed to be almost normal. It showed that the Chinese medicinal herbs mentioned above have certain influence upon the constitution of WGA receptor and protein macromolecule of sperm membrane.

Zhong Xi Yi Jie He Za Zhi. 1990 Sep;10(9):519-21, 515.

Acupuncture useful tool for improving pregnancy rate after ART(IVF, ICSI)

fertility and sterility acupunctureFertil Steril. 2002 Apr;77(4):721-4.

Influence of acupuncture on the pregnancy rate in patients who undergo assisted reproduction therapy.
Paulus WE, Zhang M, Strehler E, El-Danasouri I, Sterzik K.

Department of Reproductive Medicine, Christian-Lauritzen-Institut, Ulm, Germany. paulus@reprotox.de

OBJECTIVE: To evaluate the effect of acupuncture on the pregnancy rate in assisted reproduction therapy (ART) by comparing a group of patients receiving acupuncture treatment shortly before and after embryo transfer with a control group receiving no acupuncture. DESIGN: Prospective randomized study. SETTING: Fertility center. PATIENT(S): After giving informed consent, 160 patients who were undergoing ART and who had good quality embryos were divided into the following two groups through random selection: embryo transfer with acupuncture (n = 80) and embryo transfer without acupuncture (n = 80). INTERVENTION(S): Acupuncture was performed in 80 patients 25 minutes before and after embryo transfer. In the control group, embryos were transferred without any supportive therapy. MAIN OUTCOME MEASURE(S): Clinical pregnancy was defined as the presence of a fetal sac during an ultrasound examination 6 weeks after embryo transfer.

RESULT(S): Clinical pregnancies were documented in 34 of 80 patients (42.5%) in the acupuncture group, whereas pregnancy rate was only 26.3% (21 out of 80 patients) in the control group.

CONCLUSION(S): Acupuncture seems to be a useful tool for improving pregnancy rate after ART.

Male infertility: acupuncture improves sperm quality

fertility and sterility acupunctureQuantitative evaluation of spermatozoa ultrastructure after acupuncture treatment for idiopathic male infertility.
Pei J, Strehler E, Noss U, Abt M, Piomboni P, Baccetti B, Sterzik K.

Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China. jianpei99@yahoo.com

OBJECTIVE: To evaluate the ultramorphologic sperm features of idiopathic infertile men after acupuncture therapy. DESIGN: Prospective controlled study. SETTING: Christian-Lauritzen-Institut, Ulm, IVF center Munich, Germany, and Department of General Biology, University of Siena, Siena, Italy. PATIENT(S): Forty men with idiopathic oligospermia, asthenospermia, or teratozoospermia. INTERVENTION(S): Twenty eight of the patients received acupuncture twice a week over a period of 5 weeks. The samples from the treatment group were randomized with semen samples from the 12 men in the untreated control group. MAIN OUTCOME MEASURE(S): Quantitative analysis by transmission electron microscopy (TEM) was used to evaluate the samples, using the mathematical formula based on submicroscopic characteristics. RESULT(S): Statistical evaluation of the TEM data showed a statistically significant increase after acupuncture in the percentage and number of sperm without ultrastructural defects in the total ejaculates. A statistically significant improvement was detected in acrosome position and shape, nuclear shape, axonemal pattern and shape, and accessory fibers of sperm organelles. However, specific sperm pathologies in the form of apoptosis, immaturity, and necrosis showed no statistically significant changes between the control and treatment groups before and after treatment.

CONCLUSION(S): The treatment of idiopathic male infertility could benefit from employing acupuncture. A general improvement of sperm quality, specifically in the ultrastructural integrity of spermatozoa, was seen after acupuncture, although we did not identify specific sperm pathologies that could be particularly sensitive to this therapy.

Fertil Steril. 2005 Jul;84(1):141-7.

Acupuncture improves sperm quality (motility, normal sperm ratio) and ICSI outcomes

Influence of acupuncture on idiopathic male infertility in assisted reproductive technology.
Zhang M, Huang G, Lu F, Paulus WE, Sterzik K.

Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030.

The clinical effects of acupuncture on idiopathic male infertility in sperm parameter and on therapeutic results in assisted reproductive technology were investigated. 22 patients failed in intracytoplasmic sperm injection (ICSI) with idiopathic male infertility were treated with acupuncture twice weekly for 8 weeks, followed by ICSI treatment again. The sperm concentration, motility, morphology, fertilization rates and embryo quality were observed. Quick sperm motility after acupuncture (18.3% +/- 9.6%) was significantly improved as compared with that before treatment (11.0% +/- 7.5%, P < 0.01). The normal sperm ratio was increased after acupuncture (21.1% +/- 10.4% vs 16.2% +/- 8.2%, P < 0.05). The fertilization rates after acupuncture (66.2%) were obviously higher than that before treatment (40.2%, P < 0.01). There was no significant difference in sperm concentration and general sperm motility between before and after acupuncture. The embryo quality after acupuncture was improved, but the difference between them was not significant (P > 0.05). Acupuncture can improve sperm quality and fertilization rates in assisted reproductive technology.

J Huazhong Univ Sci Technolog Med Sci. 2002;22(3):228-30.

PCOS and Acupuncture: Electro-acupuncture normalises EV-induced changes in ovarian ARs

Effect of electro-acupuncture on ovarian expression of alpha (1)- and beta (2)-adrenoceptors, and p75 neurotrophin receptors in rats with steroid-induced polycystic ovaries.
Manni L, Lundeberg T, Holmang A, Aloe L, Stener-Victorin E.

Cardiovascular Institute and Wallenberg Laboratory, Sahlgrenska Academy, Goteborg University, SE-413 45 Goteborg, Sweden. l.manni@in.rm.cnr.it

BACKGROUND: Estradiol valerate (EV)-induced polycystic ovaries (PCO) in rats is associated with an increase in ovarian sympathetic outflow. Low-frequency (2 Hz) electro-acupuncture (EA) has been shown to modulate sympathetic markers as well as ovarian blood flow as a reflex response via the ovarian sympathetic nerves, in rats with EV-induced PCO. METHODS: In the present study, we further tested the hypothesis that repeated 2 Hz EA treatments modulate ovarian sympathetic outflow in rats with PCO, induced by a single i.m. injection of EV, by investigating the mRNA expression, the amount and distribution of proteins of alpha1a-, alpha1b-, alpha1d-, and beta2-adrenoceptors (ARs), as well as the low-affinity neurotrophin receptor (p75NTR). RESULTS: It was found that EV injection results in significantly higher mRNA expression of ovarian alpha1b- and alpha1d-AR in PCO rats compared to control rats. The p75NTR and beta2-ARs mRNA expression were unchanged in the PCO ovary. Low-frequency EA resulted in a significantly lower expression of beta2-ARs mRNA expression in PCO rats. The p75NTR mRNA was unaffected in both PCO and control rats. PCO ovaries displayed significantly higher amount of protein of alpha1a-, alpha1b- and alpha1d-ARs, and of p75NTR, compared to control rats, that were all counteracted by repeated low-frequency EA treatments, except for alpha1b-AR. CONCLUSION: The present study shows that EA normalizes most of the EV-induced changes in ovarian ARs. Furthermore, EA was able to prevent the EV-induced up regulation of p75NTR, probably by normalizing the sympathetic ovarian response to NGF action. Our data indicate a possible role of EA in the regulation of ovarian responsiveness to sympathetic inputs and depict a possible complementary therapeutic approach to overcoming sympathetic-related anovulation in women with PCOS.

PCOS (polycystic ovaries): Acupuncture reverses PCOS NFG abdundance

Electro-acupuncture reverses nerve growth factor abundance in experimental polycystic ovaries in the rat.

Bai YH, Lim SC, Song CH, Bae CS, Jin CS, Choi BC, Jang CH, Lee SH, Pak SC.

Research Division of Biological Science, Chosun University Medical School, Gwangju, Korea.

Polycystic ovary syndrome (PCOS) remains one of the most common causes of anovulation in women of reproductive age. There is some evidence that nerve growth factor (NGF) is involved in the pathogenesis of PCOS. Therefore, seeking the pathogenesis of PCOS is important for controlling fertility. In traditional Oriental Medicine, acupuncture has been used for the function of ovaries. The present study was designed to determine whether electro-acupuncture (EA) could affect experimentally induced polycystic ovary (PCO) in the rat. The two acupoints Sp-6 and E-128 were stimulated to test for efficacy in the protein expression of NGF. Polycystic ovaries were induced by a single injection of estradiol valerate (4 mg i.m.). During the experimental period of 8 weeks, some of the rats were treated with EA twice weekly; this group was compared with a vehicle-treated control group and an estradiol-injected group not subjected to EA. At day 60, the protein expression of NGF was examined by immunohistochemistry in the ovaries, the adrenal glands and some parts of the brain. The estradiol treatment induced a clear PCO appearance, and was associated with a robust increase in NGF expression in the ovaries, the adrenal glands and the brain. EA treatment partly reversed the NGF abundance, particularly in the ovaries, but not in the brain. Our data show that EA affects the NGF involvement in ovarian dysfunction. Copyright 2004 S. Karger AG, Basel

Acupuncture and PCOS anovulation: Electro-Acupuncture induces regular ovulations

Effects of electro-acupuncture on anovulation in women with polycystic ovary syndrome.
Stener-Victorin E, Waldenstrom U, Tagnfors U, Lundeberg T, Lindstedt G, Janson PO.

Department of Obstetrics and Gynecology, Goteborg University, Sweden.

BACKGROUND: The present study was designed to evaluate if electro-acupuncture (EA) could affect oligo-/anovulation and related endocrine and neuroendocrine parameters in women with polycystic ovary syndrome (PCOS). METHODS: Twenty-four women (between the ages of 24 and 40 years) with PCOS and oligo-/amenorrhea were included in this non-randomized, longitudinal, prospective study. The study period was defined as the period extending from 3 months before the first EA treatment, to 3 months after the last EA treatment (10-14 treatments), in total 8-9 months. The menstrual and ovulation patterns were confirmed by recording of vaginal bleedings and by daily registrations of the basal body temperature (BBT). Blood samples were collected within a week before the first EA, within a week after the last EA and 3 months after EA. RESULTS: Nine women (38%) experienced a good effect. They displayed a mean of 0.66 ovulations/woman and month in the period during and after the EA period compared to a mean of 0.15 before the EA period (p=0.004). Before EA, women with a good effect had a significantly lower body-mass index (BMI) (p<0.001), waist-to-hip circumference ratio (WHR) (p=0.0058), serum testosterone concentration (p=0.0098), serum testosterone/sex hormone binding globulin (SHBG) ratio (p=0.011) and serum basal insulin concentration (p=0.0054), and a significantly higher concentration of serum SHBG (p=0.040) than did those women with no effect. CONCLUSION: Repeated EA treatments induce regular ovulations in more than one third of the women with PCOS. The group of women with good effect had a less androgenic hormonal profile before treatment and a less pronounced metabolic disturbance compared with the group with no effect. For this selected group EA offers an alternative to pharmacological ovulation induction.

Acupuncture normalizes dysfunction of hypothalamic-pituitary-ovarian axis

Acupuncture normalizes dysfunction of hypothalamic-pituitary-ovarian axis.

Chen BY.

Institute of Acupuncture, Shanghai Medical University, P.R. China.

This article summarizes the studies of the mechanism of electroacupuncture (EA) in the regulation of the abnormal function of hypothalamic-pituitary-ovarian axis (HPOA) in our laboratory. Clinical observation showed that EA with the effective acupoints could cure some anovulatory patients in a highly effective rate and the experimental results suggested that EA might regulate the dysfunction of HPOA in several ways, which means EA could influence some gene expression of brain, thereby, normalizing secretion of some hormones, such as GnRH, LH and E2. The effects of EA might possess a relative specificity on acupoints.

Acupunct Electrother Res. 1997;22(2):97-108.

Chinese herbs – higher success rates of pregnancy (unexplained infertility)

Measuring the Effectiveness of Chinese Herbal Medicine in Improving Female Fertility

By: Trevor A. Wing & Elke S. Sedlmeier

Aim: To determine the relationship between female fertility indicators and the administration of
Chinese herbal medicine (CHM).

Design: A prospective cohort clinical study to measure accepted bio-medical
factors that affect female fertility and to determine if CHM can improve these factors as well as pregnancy outcome.

Setting: A private practice specialising in treating infertility with traditional Chinese medicine (TCM). The study took place between November 2003 and December 2004. Patient(s): Fifty women with the Western medical diagnosis of unexplained infertility.

Interventions: One monitored menstrual cycle measuring pre-treatment fertility factors, followed by treatment with Chinese herbal medicine and subsequent measurement of the changes in the same fertility factors.

Results: Significant differences were observed between the two time points for the majority of factors measured. Pregnancies in the sample group recorded 6 months after commencement of the last treatment were 28, with 11 live births and 7 miscarriages.

Conclusion: The study outcome demonstrates that using Chinese herbal medicine results in higher success rates of pregnancy, with no patient side-effects and a reduction in the category of patients conventionally classified as having unexplained infertility.

Introduction

The research question this study Read more

Combination of western and Chinese medicine is the most effective method in treating tubal obstruction

FALLOPIAN TUBE DYSFUNCTION AND CHINESE HERBAL MEIDCINE

A study was carried out in Guangzhou, China, to find an effective treatment for tubal obstruction. The results of 120 women divided into three treatment groups were compared. One group received a combination of Western medical treatment and Chinese herbal medicine, one group received Chinese herbal medicine only and another group received Western medical treatment only. After treatment, the fallopian tube patency rate 86.7% and the pregnancy rate 85.0% in the TCM/ WM group, 66.7% and 63.3% in the TCM group and 53.3% and 50% in the WM group respectively. The effectiveness in the combination group was significant. The authors conclude that the combination of western and Chinese medicine is the most effective method in treating tubal obstruction.
Kang JL, XIa W, He QY.'[Clinical study on treatment of oviduct obstruction by integrative traditional Chinese and Western medicine]. Zhongguo Zhong Xi Yi Jie He ZaZhi. 2001, 21 (6): 416-8.

Luteal-phase acupuncture improves outcomes of IVF/ICSI

fertility and sterility acupunctureDieterle S, Ying G, Hatzmann W, Neuer A.

Fertil Steril. 2006 May;85(5):1347-51. Epub 2006 Apr 17.

Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Witten/Herdecke, Dortmund, Germany. Dieterle@IVF-Dortmund.de

OBJECTIVE: To determine the effect of luteal-phase acupuncture on the outcome of IVF/intracytoplasmic sperm injection (ICSI). DESIGN: Randomized, prospective, controlled clinical study.

SETTING: University IVF center.

PATIENT(S): Two hundred twenty-five infertile patients undergoing IVF/ICSI.

INTERVENTION(S): In group I, 116 patients received luteal-phase acupuncture according to the principles of traditional Chinese medicine. In group II, 109 patients received placebo acupuncture. MAIN OUTCOME MEASURE(S): Clinical and ongoing pregnancy rates.

RESULT(S): In group I, the clinical pregnancy rate and ongoing pregnancy rate (33.6% and 28.4%, respectively) were significantly higher than in group II (15.6% and 13.8%). CONCLUSION(S): Luteal-phase acupuncture has a positive effect on the outcome of IVF/ICSI.

Chinese medicine/herbs and PCOS

Clinical observation on treatment of 43 women with polycystic ovary syndrome based on syndrome differentiation

[Article in Chinese]

Jia LN, Wang XJ.

Department of Gynecology of Integrative Medicine, Huashan Hospital, Fudan University, Shanghai 200040, China.

OBJECTIVE: To investigate the therapeutic effect of treatment based on syndrome differentiation and its influence on the serum levels of testosterone and insulin in women with polycystic ovary syndrome (PCOS). METHODS: Forty-three women, diagnosed with PCOS as well as syndrome of kidney yin deficiency or syndrome of spleen qi deficiency, were enrolled in the study. Twenty-five PCOS women with syndrome of kidney yin deficiency were treated with traditional Chinese herbs for nourishing yin to reduce fire (nourishing yin group), and 18 PCOS women with syndrome of spleen qi deficiency were treated with herbs for invigorating spleen and replenishing qi (replenishing qi group). Body mass index (BMI), waist-to-hip ratio (WHR), waist circumference (WC), and the serum levels of insulin and testosterone before and after treatment were detected. RESULTS: Among the 43 cases, 20 cases had high serum testosterone level, in which 13 cases with syndrome of kidney yin deficiency, 7 cases with syndrome of spleen qi deficiency, but the difference had no statistic significance; 17 cases had high serum insulin level, in which 11 cases with syndrome of spleen qi deficiency, 6 cases with syndrome of kidney yin deficiency, the difference had statistic significance (P<0.05). In nourishing yin group, the serum levels of insulin and testosterone declined after treatment (P<0.05), and BMI, WHR and WC showed no significant changes. In replenishing qi group, the serum level of insulin declined after treatment (P<0.01), and BMI, WHR, WC and the serum level of testosterone showed no significant changes. CONCLUSION: Traditional Chinese herbs for nourishing yin to reduce fire can significantly reduce the serum levels of testosterone and insulin in PCOS women with syndrome of kidney yin deficiency, and herbs for invigorating spleen and replenishing qi can significantly reduce the serum level of insulin in PCOS women with syndrome of spleen qi deficiency. Zhong Xi Yi Jie He Xue Bao. 2006 Nov;4(6):585-8.

Acupuncture on the day of IVF/ICSI embryo transfer significantly improves the outcome

Acupuncture on the day of embryo transfer significantly improves the reproductive outcome in infertile women: a prospective, randomized trial
National Institute of Environmental Health Sciences

Vienna, Austria: There was heartening news today (Wednesday 3 July) for would-be parents worried because they had difficulty conceiving. A new study being presented to Europe’s leading reproductive medicine conference shows that most healthy couples concerned because the woman was not pregnant after a year of trying will conceive during the second year.

A US team from the National Institute of Environmental Health Sciences in North Carolina who analysed data on 782 couples from seven European cities1, concluded that even when the woman was aged between 35 and 39, fewer than 1 in 10 failed to conceive after 2 years unless the male partner was over 40.

Lead investigator Dr David Dunson suggested that couples should be patient and doctors should not intervene too fast with assisted reproductive techniques unless there are known reasons for a couple not conceiving naturally within a year.

He told the annual conference of the European Society of Human Reproduction and Embryology that recent research undertaken by his team showed that fertility in women started to decline as early as the late 20s and for men from their late 30s2 . But, this was due primarily to declines in the per menstrual cycle conception rate and not to an increase in the proportion of couples unable to achieve an unassisted pregnancy.

Now his team has extended their research using data from the European Fecundability Study to see what the implications are for fertility rates overall.

“On average the time to pregnancy increases with the age of the woman. The percentage failing to conceive within a year ranged from 8% for 19-26-year-olds to 13 to 14% for 27 to 34-year-olds to 18% for 35-39-year-olds.”

“But, regardless of age, most of the women who failed to conceive within the first 12 cycles conceived in the next 12. Only 3% of 19 to 26-year-olds, 6% of 27 to 34-year-olds and 9% of 35 to 39-year-olds failed to conceive in the second year, provided the male partner was aged under 40. Starting in the late 30s though, male age was also important: it meant that the percentage of failures after one year for women aged 35 to 39 rose from 18% to 28% if the male partner was over 40. After the second year the figure was 9% with male partners under 40 and 16% with male partners over 40.”

Dr Dunson said there were clear increases with age in the number of menstrual cycles needed to achieve pregnancy and in the probability of being classified as clinically infertile – a definition applied after a year of trying to conceive.

But, their research had clearly shown that among outwardly healthy couples with no known conditions associated with infertility, most who failed to conceive naturally within the first year will conceive naturally in the second year – regardless of age.

“So, in the absence of clinical indicators of infertility in addition to a long time to pregnancy, it may be appropriate to delay assisted reproduction until the couple has failed to conceive naturally in 18 to 24 months. There is a large amount of normal variability in fertility and many couples having below average, but normal fertility may fail to conceive within a year. This is particularly true for older couples, many of whom fail to conceive within the first year but are successful in the second.”

He said it was important for doctors to avoid recommending assisted reproduction too soon due to well-documented side effects. “Fertility treatment, such as IVF and ICSI, can result in an increased risk of multiple pregnancies, pregnancy complications, low birth weight, major birth defects and long-term disability among surviving infants. In addition, the chance of success with ART decreases with age, while the side effects increase in prevalence.”

1 Data were drawn from a large multinational study – the European Study of Daily Fecundability. It enrolled 782 women aged between 18 and 40 from seven centres – Milan, Verona, Lugano, Dusseldorf, Paris, London and Brussels. The participants kept daily records of basal body temperature and recorded the days on which intercourse and menstrual bleeding occurred. Data on 7,288 menstrual cycles contributed to the study.

2 Changes with age in the level and duration of fertility in the menstrual cycle. Human Reproduction. D. Dunson et al. Vol. 17. No 5. pp 1399-1403

Coffee linked to doubled fetal death rates

Coffee linked to doubled fetal death rates
American Journal of Epidemiology 2005; 162: 983-90

Investigating whether coffee consumption during pregnancy is associated with late fetal death.

Women who drink eight or more cups of coffee a day are twice as likely as women who do not drink coffee to miscarry or have a stillbirth, a survey suggests.

While adjusting for other risk factors attenuated the association, the researchers think the results justify advice for pregnant women to drink no more than three cups of coffee a day.

Coffee drinking has been repeatedly associated with adverse pregnancy outcomes, and plausible mechanisms have been proposed to explain the link; yet some people still question its risks, explained lead author Bodil Hammer Bech from the University of Aarhus in Denmark.

To investigate, Bech and colleagues surveyed 88,482 pregnant women enrolled in the Danish National Birth Cohort about their coffee intake and potential confounding factors, at 16 weeks’ gestation.

After adjustment for confounders, the researchers found that the risk of fetal death was increased by 3 percent for women who drank one-half to three cups of coffee daily, compared with abstainers, by 33 percent for those who drank four to seven cups a day, and by 59 percent for women who drank eight or more cups daily.

No link was found between fetal death and tea or cola intake, however, indicating that some compound in coffee other than caffeine may underlie the observed effect.